Controlling Healthcare

| Thu Nov. 19, 2009 11:13 AM EST

Ezra Klein on the cost control portions of the Senate healthcare bill:

If this piece of the bill was passed on its own, it would be the most important cost control bill ever considered by the United States Congress. But you could never have passed it on its own. You needed the coverage to make the grand bargain work. Republicans like to call this bill a trillion-dollar experiment to expand the health-care system, and in some ways, it is. But it's also a multitrillion-dollar experiment to cut costs in the health-care system, and it deserves credit for that, and support from fiscal conservatives. It's easy to talk about cutting costs, but this is the chance for people to actually do it.

This is a consistently underappreciated aspect of the current reform efforts in general and the Senate bill in particular.  Are they Rube Goldberg concoctions?  Sure.  Might they fail?  Sure.  But they are, by several miles, more ambitious attempts to rein in both Medicare costs, and healthcare costs generally, than anything ever done.  Nothing else even comes close. MedPAC, Medicare growth targets, excise taxes on Cadillac plans, givebacks from Pharma, a modest public option, delivery reforms — these are all pitifully inadequate to the task, but they're also the best prospects for healthcare cost control we've ever seen.

Right now Democrats are stuck.  For short-term political reasons, Republicans have decided to demagogue cost-control because it helps them gin up opposition to healthcare reform in general.  This means Dems can't really afford to do more on this front even if they wanted to.  But at least these bills set the stage.  They put in place both goals and programs that can be built on later if America's party of fiscal conservatism ever decides to stop throwing temper tantrums and instead join in seriously addressing America's long-term fiscal problems.  That probably won't be until after 2012, but if reform passes this year at least we will have gotten started by then.